Protecting Yourself from Medical Billing Mistakes

Photo: Darren Kidd

Even though many of us may take our health for granted, one thing that strikes a chord in everyone is the high price of medical care. Between the rising cost of routine doctor visits and medication to the regular increases in our insurance premiums, health care is on most people’s minds.

And yet, how many of us really take the time to understand all that we’re being charged for? Granted, medical bills can read as if they were written in another language, and for all intents and purposes, they are. That is because medicine, not unlike law, is filled with the esoteric language of the profession. Sprinkle in a generous amount of Latin, and it can leave you feeling pretty helpless and lost.

Furthermore, many of us don’t go to see a doctor or a lawyer until we need one, and at that point we are not necessarily in the best position to argue every nickel and dime. On the other hand, is complete ignorance the answer? Or is it better to take the time to understand all that we are being charged for, even if it’s a hassle and may intimidate us?

Well, it’s worth it when you consider this: as seen recently on Good Morning America, it turns out that up to 80% of medical bills contain errors in them, according to Medical Billing Advocates of America. These errors arise from a variety of sources, from simple clerical errors like typos or duplicate charges, to more serious incidences that include charging patients for drugs or services that were never rendered and inflating the price of drugs or supplies. And, of course, there is always the possibility of outright fraud.

Whatever the reason, the end result is the same - it ends up costing you more. Medical debt, after all, is the second leading cause of bankruptcy in this country, second only to credit card debt. And to make matters worse, these mistakes might even result in your insurance carrier refusing to cover services that you might need.

It is therefore important to take the time to really understand what you’re paying for, even if the people who are supposed to answer your questions (that would include doctors, nurses and hospital administrators) are not going out of their way to help you.

So in an effort to protect your rights as a patient and possibly even save some money, keep these things in mind the next time you get your bill:

1. Read your bill. Pay attention to every charge, making sure that things are in order. If something seems wrong, like a redundant charge or something you don’t recognize, ask questions. And don’t worry if they don’t seem thrilled to decipher every acronym for you. It’s your money, not theirs, so take the time to account for every charge, and if they can’t help you, ask for someone who can.

2. Know your options. Question high charges for everyday things that cost a lot less outside the hospital, like tissue or bandages, and find out if you have lower cost options. This is especially true for prescription medication, where generic equivalents that do the same job can cost a lot less.

3. Keep track of time. For a hospital stay, keep careful track of the duration that you are there and understand how they charge for your stay. The cost of an additional day could amount to hundreds of dollars in extra expense.

4. Be organized. Keep careful records of your conditions, including when they were first diagnosed or treated. Insurance companies can be picky about things like pre-existing conditions that could lead to a denial of coverage.

5. Be persistent, and don’t give in too easily. This is important when dealing with your doctor’s office as well as your insurance company. If you’re not satisfied with a response, keep trying until you get an answer. Remember, the squeaky wheel gets the oil, and the people who are helping you are not as invested in your interests (it’s your money) and more than likely won’t be as enthusiastic to resolve the issue, so it’s up to you.

6. Talk to people. This includes friends, relatives, and colleagues. Chances are they’ve traveled through the medical maze themselves or know someone who has and can offer some advice.

7. Seek out help. If it seems as if your efforts are going nowhere, there are professional services that can help. Outside of getting an attorney, several advocacy groups have formed designed specifically to help people sort out their medical bills, and a simple Google search for “medical billing errors” will turn them up. They generally charge a fee, but it can be worth it if they end up saving you thousands of dollars, and many of them work on a contingency basis.

It you think you might be the victim of fraud, contact your insurance company or the FBI. For more information, the website of the National Health Care Anti-Fraud Association can provide information and advice.

Whatever you do, be informed, because your money and your health might be at stake. Always keep in mind, however, that hospitals are not necessarily out to rip you off and many of these situations arise from simple and innocent human errors that can easily be resolved if you just take the time.

And time, as the saying goes, is money. Speaking of which, maybe the next step will be to find out what all those legal fees that lawyers charge are actually for.

Then again, you’d probably have to hire an attorney to do that.

Do you have a medical billing experience that you'd like to share with us? If so, we'd love to hear it, and thanks.

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Guest's picture

I was recently charged an out of control amount for pills that were handed to me...not cover they said, I took them on my own! However since I DID take them on my own I knew I had only taken two not three that I was charged for! After checking they agreed they made a mistake and changed the charge. Still too high but at least right.

Guest's picture

One hospital had a well known habit of having people ready for release at 8am but not finishing to release them until 3pm, making them sit there all day. Their day rolls over at 3pm so they get to charge for another day. Knowing this, the last time one of us was in the hospital they tried to pull this. We waited a few hours in case they actually were trying to track something down. Then we told the staff we were leaving right now, bye see ya. They suddenly then had all of our go home things ready to go when it was obvious we were leaving no matter what.

Another scam to watch for is having minor diagnositics charged as hospital outpatient when they could easily be done at a clinic. A local health care provider "centralized" all of their bloodwork and imaging (including xrays). So they send you to the hospital campus but not actually into the hospital, instead to a clinic building on campus. Then they slap a hospital bracelet on you as part of checking in at the counter. This little trick allows them to charge 3x as much for every diagnostic done.

Some states require providers to put prices on their website or a state website. They can be a useful tool to see what is being charged.

Julie Rains's picture

Make sure that the provider (often a third-party provider such as a lab but also the physician) has your correct insurance info. I know, I know -- the office staff always makes me give my  insurance card before anything happens; but they are not necessarily diligent about passing that info along. Once, a scan of my card went bad (no one checked the scan at the time of service); another time, the lab couldn't read the fax sent to them with my insurance card. If no insurance has been applied to the payment, then find out why (or why not).

Know what your insurance covers and make sure it gets covered. I went for a screening covered by my insurance but the visit was coded for a disease (allergies), which wasn't covered under my deductible. I had to get the code changed based on records from the visit -- it took a while but they finally corrected it.

I was not successful in getting the hospital where my first son was born to follow their own billing procedures. Its rule is to charge nursery fees at midnight -- he was born after midnight and released before midnight the next day. I was still charged the full price and couldn't get the hospital to reduce its fees (I would have accepted a few dollars!) I went to another facility for my next child.

When you are protesting charges, ask A/R to note that the charges are being "disputed" to avoid late fees, collection agencies, etc.



Guest's picture

Medical biling advocates make the most sense for people with a chronic or ongoing illness, or for those who may have had a recent procedure done, such as a surgery.

Here's how you can find a medical billing advocate in your area, as well as additional info on how they work.

Guest's picture

I work for an insurance company. Before you pay your medical bills compare them to the insurance company's explaination of benefits to the bill. The provider may have billed you for money they should have writen off according to their contract.

Fred Lee's picture

Thanks for sharing your experiences, it's helpful to know what to look out for and how you dealt with it. And thanks for the link, Dawn.

I had coverage once denied because I had changed carriers to have the procedure covered, but it was diagnosed under my previous insurance, so it was considered a pre-existing condition. I had to fight tooth and nail to get them to pay for it, but after a lot of legwork, they finally did, saving me a couple of thousand dollars.

I've also been billed for things I'd never had done. When I lived in New York, there was a Fred Lee who shared my doctor, and they were billing me for his visits, after I'd moved out of New York. It was a total pain to deal with, but I resolved it.

I'm guessing these things happen a lot more than we even know, and a lot of it probably just gets paid without much thought. Too bad.

Guest's picture

Also don't take an insurance claims denial lying down. They are frequently mistakes or just hoping you will let it go and they do not have to pay it.

I had a run of these with one insurance company. I was tipped off by one doctor's insurance person that my insurance company had a really bad habit of "losing" the claims submissions repeatedly. I mentioned this to the insurance person at the other doctors office having the same problem with my insurance and they concurred. I was lucky that the insurance company office was in the same town and I had some time off. I drove to both doctors and picked up copies of the insurance claim forms from each. Then I hand delivered them to the front desk of the companies corporate office and politely refused to leave until I was given a receipt of some sort for each. I never had a claim get lost ever again, before this they were losing almost all of them. It was rather extreme but it worked.

I also recently found out that one health system in town is charging 30-50% (or more) than the other health system in town. A bill that would have easily cost me $500 out of pocket at the other place cost me $75 including my copay.

Guest's picture
Stephanie: Certified Medical Coder

I am a Certified Medical Coder currently working for a third party billing company. As a coder I also review claims denials for billing and coding errors and correct them for re-submission. There is a long list and a wide variety of mistakes that can create medical claims errors and payment rejections that, if uncorrected, get passed along to the patient. The claims submission process is lengthy and complicated and Third Party Payers and Medicare are looking for ANY reason to deny payment.
A few examples of what I see on a daily basis are:
Incorrect patient Info (age, DOB, Address, SSN)
Incorrect or out-dated Insurance Info
Medical Transcription Errors
Coding errors (Incorrect CPTs, Dx's, Modifiers, Bundling, etc.)
Missing Physician Info and/or referring Physician Info
Timely Filing (most payers have a limited time frame in which the physician can file the claim, after which they will reduce or refuse payment.)
But what I have seen most often is a lack of or missing information from the record of the patients visit.
Coding and Billing guidelines are also regionally specific and payer specific.
Something as simple as your doctor failing to include a supporting diagnosis (ie. difficulty breathing = respiratory testing) is also a very common reason for payment denial. Every rejection for payment gets passed onto the patient.
So there are many scenarios to consider other than just fraudulent billing as to why you, the patient, are being billed and how that amount was calculated. For that reason I highly recommend seeking out the services of a professional to assist you with billing errors. Its not just the services on the bill that need to be reviewed for accuracy but the entire billing and coding process that began the moment you walked out of the doctors office or hospital. Any number of mistakes or errors could have been made along the way that the patient would never ever any idea to question or review.

Guest's picture

I would like to know with regard to how much a doctor can charge a patient for a missed appointment are there any guidelines?

I missed an appointment for a Dr. Jeffrey Graf some two years ago. First he had his office manager come up to me while on a visit to say that he would take $50 instead of $100 if I paid him $50 on the spot. The answer I gave was no -- Dr. Graf knows I just became unemployed I don't walk around with $50. Also, the amount which I was advised I owed on that day was $110 dollars ten dollars of which was a co-pay which I stated I had already paid. I paied that co-pay again, as well as the co-pay for that date. Following this I received a bill in the mail with a nasty note that I better pay $110 (ten dollars overhcarge since I had paid that same co-pay twice -- once prior and on the last visit when they asked me for the $110 (ten of which I paid for a second time). After that warning to pay the $110 I got a threatening note saying that it would be doubled. Then I started getting bills for $210 and then the $210 was placed on my credit report as an upaid medical bill. The funny thing is the receptionsit had admitted that we had "rescheduled" the so called no-show for another date but that she had forgetten to make that notataton. I was planning on paying the $100 but when I saw the bill for $110 again, and when the doctor's office started sending nasty and threatening notes I was so disgusted I just ignored them and decided to stop using that doctor.

Guest's picture

My husband was having hernia. His doctor referred him to a radiology facility, named CPMC in San Francisco, in the same professional building for abdomen CT scan. The scan was about 15 minutes. He was surprised with the invoice of $7,800.00 for this 15 minute scan. His insurance paid $2,450.00. CPMC demands him to pay the remaining $3,550.00, and aggressively sent his account to a collection agency. This is an outrageous overcharge. I heard from a doctor that this service costs only $400 if paid with cash (no insurance). Can you believe it, $7,800 for a 15 minutes scan? It's a consumer rip-off! Can someone please help with some idea or some ways to report and get them fix their fraudulent and abusive billing.

Guest's picture

Great advice . . . mistakes happen and so does fraud . . .

Best to check it out and question everything.

Guest's picture

i went to er for a peice of metal in my eye doc told me that he didnt want to touch it and recomended eye doc he new he even made call i went there he removed metal and gave me meds for it and i payed him then hospital sent me a 485 dollar bill for exam even though they didnt do anything now its on my credit cause i dont think i should have to pay them when they didnt do anything i told them i had metal in my eye so i didnt need them to tell me that they said i still owe for exam not sure what to do a lawyer wants 500 to start anything

Guest's picture
Sandra Eichlerq

My medical billing code information is a nightmare now. I do not think there is a number I can put on the time and hours I have spent suffering when medical code was not declared an emergency when my gynecologist sent me to he Kent General Hospital and BCBS Highmark is denying for incorrect code. I am at my wits end trying to fix this and am literally getting sicker over this debacle. It is a solid nightmare and I reach out for last two months with the total runaround and no help. I would like some direction to fix this absolute nightmare which even caused me to drive home at 3:15 a.m. on January 24, 2014 pumped full of morphine. I am so disillusioned with our medical system and angry at doctor who sent me there as an emergency. I have no idea how this has become such a nightmare that I have battled for two months. It is a nightmare and I say either pray you die or never listen to your doctor about going to the emergency room. I now am looking at mounds of bills that I was assured and told was emergency and no worries well now I am in full fledged nightmare with office telling me there is nothing I can do. Well, I am doing something and am so done with our corrupt medical system.